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Keys to the Conrad 30 Program

As the physician shortage grows more severe, particularly in traditionally underserved rural and inner city areas, physician recruitment professionals will find it more challenging than ever to identify and secure the candidates their organizations need. Candidates of all types will be in demand. Some recruiters may be pursuing International Medical Graduates/IMGs for the first time or with very little experience in this area. It is important to have a clear understanding of the immigration laws and programs governing the recruitment, employment and retention of these candidates.

Of particular importance is the Conrad State 30 Program. Named after the original sponsor, Senator Kent Conrad (D-ND), the Conrad State 30 Program was initiated in 1994. It permits international medical graduates (IMGs) who have completed their graduate medical education in the US on J-1 visas to receive a waiver of the two-year home residency requirement if they practice in certain medically underserved areas. The two-year home residency requirement obliges J-1 visa holders to return home for two years once their US training is completed before they can apply for a job in the US. President Obama recently signed Senate Bill 3245, which extends the Conrad 30 Program for three more years.

Under this program, each US state can sponsor up to 30 primary care physicians and/or specialists each fiscal year for J-1 waivers. Although each state has formulated its own policies and program guidelines, the basic requirements are:

The IMG must agree to work in a full-time capacity (40 hours a week) in H-1B status at a practice site located in a federally designated Health Professional Shortage Area (HPSA), a Medically Underserved Area (MUA) or a Medically Underserved Population (MUP).

Up to 10 of a state’s 30 annual waiver slots (the so-called “Flex 10”) may be used for practice locations outside of designated shortage areas where the employer can demonstrate that the physician will serve patients who live in shortage areas.

The IMG must sign a contract with the health care facility to work at the approved practice site for a period of not less than three years.

The IMG must agree to begin employment at the approved practice site within 90 days of receipt of the wavier.

If necessary, the IMG must obtain a “No Objection” letter from his or her home country indicating that the home country will not block or dispute the physician’s efforts to obtain a J-1 waiver.

To apply for the J-1 waiver, the IMG must request sponsorship from the department of health in the state where he or she intends to practice medicine and complete the J-1 Visa Waiver Application. If the state agrees to sponsor the physician for a J-1 waiver, it will forward the application to the US Department of State for a recommendation to the US Citizenship & Immigration Services (USCIS). USCIS is the final authority and determines whether or not to grant the waiver.

Once a J-1 waiver is granted, the employer must submit an H-1B petition and request for a change of status from J-1 to H-1B to the USCIS. Physicians who receive waivers under the Conrad 30 program are exempt from the annual H-1B cap.

Some states attract more IMGs than others. It is very important that physicians and their employers examine the state’s program guidelines and ensure a complete and proper application is lodged in a timely manner, as most applications are accepted on a first-come, first-served basis. A poorly prepared J-1 waiver request may result in the IMG physician missing out on one of the 30 slots or one of the 10 Flex spots.

The Conrad 30 Program is the one avenue open to many IMGs hoping to practice medicine in the US. ASPR members and other physician recruitment professionals who are familiar with the program will have an inside track to securing these key candidates.

Carl Shusterman served as a trial attorney with the US Immigration and Naturalization Service and is principal of The Law Offices of Carl Shusterman.